1881614725 NPI number — ISABEL R. DE MASTER L.C.S.W.

Table of content: (NPI 1518913052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881614725 NPI number — ISABEL R. DE MASTER L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE MASTER
Provider First Name:
ISABEL
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881614725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07401-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-327-2717
Provider Business Mailing Address Fax Number:
201-327-4105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 FRANKLIN TPKE
Provider Second Line Business Practice Location Address:
FLOOR 2 SUITE 4
Provider Business Practice Location Address City Name:
WALDWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07463-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-447-1220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  44SC00128800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99380 . This is a "UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141381 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5643121 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1536350 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".